Evaluating Toronto Hospitals' COVID-19 Visitor Policy Using Accountability for Reasonableness

Area of Science:

• Healthcare policy analysis
• Public health ethics
• Hospital administration

Background:

• The COVID-19 pandemic necessitated rapid policy development for hospital visitor restrictions.
• The Toronto Region COVID-19 Hospital Operations Table implemented a visitor restriction policy in March 2020.
• Evaluating the fairness and impact of such policies is crucial for patient-centered care.

Purpose of the Study:

• To assess the development and implementation of a COVID-19 visitor restriction policy using the accountability for reasonableness (A4R) framework.
• To identify potential disadvantages and unaccounted costs to patients resulting from the policy.
• To provide recommendations for improving future healthcare visitor policies.

Main Methods:

• Qualitative study involving nine interviews with policy developers and implementers.
• Application of the accountability for reasonableness (A4R) framework to analyze policy development and implementation.
• Thematic analysis of interview data to identify key findings and concerns.

Main Results:

• Participants perceived the policy development and implementation as fair, meeting A4R principles.
• Key themes indicated the policy disadvantaged patients unable to self-advocate.
• Unaccounted patient costs, including lost time and function, were identified.

Conclusions:

• While the policy met procedural fairness criteria, it had unintended negative consequences for vulnerable patient groups.
• Healthcare visitor policies should proactively integrate equity considerations.
• Predetermined metrics are needed to measure and mitigate patient harms.